Patients admitted to hospital spend almost 5 times longer in ED than non-admitted

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10% spend more than 28 hours in the ED before admission

October 7, 2014—1 in 10 emergency department (ED) patients required admission to hospital in 2013–2014, and they spent 4.7 times longer in the ED than those who were not admitted, reveals new data from the Canadian Institute for Health Information (CIHI). Of the 1 million patients admitted, 1 in 10 spent more than 28.4 hours in the ED first.

When looking at all ED visits, however, 9 out of 10 were completed in 7.5 hours or less.

Waits for inpatient beds varied by the severity of the situation: ED patients who needed an operating room or critical care bed had waits almost 3 times shorter than those who needed an inpatient bed in another unit (e.g., cardiology, respirology).

“We analyzed more than 10 million ED visits. That represents approximately 60% of the ED visits in Canada, which underlines how busy this part of the health system is,” explains Greg Webster, the director of Acute and Ambulatory Care Information Services at CIHI. “Our findings highlight the persistently long ED visit times for admitted patients and how this affects seniors in particular. It is important to note that 90% of all ED visits were completed in 7.5 hours or less.”

Seniors tend to be in EDs the longest

1 in 4 of the seniors who visited an ED was admitted to hospital. Of these patients, 1 in 10 spent more than 31 hours in the ED before being admitted, compared with more than 25.4 hours for 1 in 10 younger patients.

Chronic conditions—such as diabetes, high blood pressure and arthritis—are more prevalent among people age 65 and older. These conditions can require hospitalization if not managed properly and complicate diagnosis and treatment of other illnesses and injuries. That is one reason why seniors are more likely to require admission to hospital and, because the appropriate inpatient beds are unavailable, have longer ED visits than their younger counterparts.

“In emergency departments, patients requiring hospital admission often face long waits until beds become available,” says Dr. Howard Ovens, director of the Schwartz/Reisman Emergency Centre at Mount Sinai Hospital, professor of family and community medicine at the University of Toronto and Ontario Provincial Lead (advisor to the government on emergency medicine policy). “Across Canada, this has been a particularly difficult problem with broad implications; overcrowding in EDs is largely due to the inability of admitted patients to access inpatient beds.”

When looking at all patients, the leading conditions for which people were admitted to hospital from the ED were

  • Chronic obstructive pulmonary disease (COPD);
  • Heart failure; and
  • Pneumonia.

For this analysis, time spent in the ED starts when a patient is triaged or registered and ends when he or she leaves the ED. Patients may receive assessments, tests, diagnostic procedures and treatments. Those who are not admitted to hospital leave the ED when discharged. Those who are admitted wait until the appropriate bed or operating room becomes available before they are transferred out of the ED.

CIHI publishes data and reports focused on EDs and why people visit them to shed light on this aspect of the health system.